C09991817 / invoice 10000

Reason: Skin Check Very Itchy KKAppointment Notes: Overdue remindersHistory: Owner reports Benjamin has been doing okWas very itchy earlier in the year and restarted on cytopoint, which worked well for the first 3 weeks, then pruritus restarted. Cytopoint was repeated when due, but did not seem to last as longHas been EDDU normallyNo CSVDNow Ben is very itchy again, particularly around eyes. Overnight, ben has scratched his periorbital area quite significantly to the point of causing hair loss and bleeding.Parasite preventatives: utd Bravecto and milproCurrent medications: cyclosporin and itraconazole as rx by dermatologists Examination:HR -  120         RR - pant       T -  nt      mm - pink and moist           CRT <2sec           Weight - 26.6Mentation - BARBody score - 5/9Eyes - bilateral corneal opacitiesPeriocular area: significant alopecia and erythema, with some purulent discharge and crusting bilaterally Ears - NADOral exam - NAD Respiratory system - NAD. Normal rate and effort with clear bronchovesicular sounds bilaterallyLymph nodes - NADHeart character and rhythm - NAD. No murmrus or dysrrhythmias identified. Femoral pulses normokinetic and synchronous.Abdominal palpation - NAD, soft and comfortable with no organomegally identified.Rectum/Perineum - NADUrogenital system - NADSkin/integument - several cutaneous and subcutaneous masses as previously noted Lick granuloma-type wounds on dorsal aspect of feet as previously noted Fleas - not presentMusculoskeletal System - NAD, able to rise and ambulate without lameness. Good ROM and no pain in any joints, spine or limbsNeuro - NAD Assessment: Increased pruritusSevere periocular alopecia and pruritus - mites? Pyoderma secodnary to allergic skin disease?Laboratory: No mites noted on skin scrapeAssessment: Advised no mites on skin scrape today, however false negatives common especially if patient on bravecto. Recommended repeating cytopoint at higher dose today - avoid JAK inhibitors for now due to potential for immunosuppression and review at dermatologists as has an appt booked in 2 weeksTreatment: Cytopoint 40mg (B) 845661 (E) 02/27 Diluted iodine around eyes BID E-collar at all timesPlan:Review with dermatologists to discuss if commencing JAK inhibitors is wise. Consider another skin scrape    Vital Signs    Weight: 26.6;